November and December is always an especially busy time of the year in the life of a general surgeon (attributable to a large extent to the rise of b.s. high deductible insurance plans which everyone seems stuck with nowadays) and so I haven't been able to post much to the blog. But I have been taking notes on some recent developments related to head trauma, football and CTE. Let's get to some of them now.

1) Last week, Vice told the harrowing, heart breaking story of Zack Langston, a 26 year old former high school and college football player who spiraled downward, consumed by paranoia, depression and despair, ultimately taking his own life at the age of 26.

Following his death, Zack's family had his brain studied by the eminent Boston pathologist Ann McKee. The post-mortem diagnosis was confirmed to be Chronic Traumatic Encephalopathy (CTE). The only surprising thing was the extent of pathognomonic tau tangles throughout his brain. According to Dr McKee, the disease was as advanced in Zack's brain as what she found in the brain of 42 year old former NFL star Junior Seau. "It's getting to be pretty common for us to see cases in twenty-somethings", McKee said. Further from the article:

McKee's brain bank found CTE in the brain of Patrick Risha, a former Dartmouth football player who committed suicide at age 32; in the brain of Michael Keck, a high school star who played just one year of college football and died at age 25; in the brain of Joseph Chernach, who played Pop Warner and prep football and committed suicide at age 25; and in the brain of Nathan Stiles, who died at age 17 from a brain injury suffered during a high school football game. In total, McKee says, she has found CTE in the brains of 41 of 50 former college football players her brain bank has examined, and six of 26 former high school players. As part of a proposed settlement of a class action brain trauma lawsuit against the National Collegiate Athletic Association, actuaries for the organization estimate that for a period covering college sports careers beginning between 1956 and 2008, approximately 50-300 former athletes per year will be diagnosed with the disease.

Questions certainly remain. Why are some younger people more susceptible to brain trauma and the development of CTE than others? What triggers this early onset form of the disease? And how can we do a better job of identifying those youths who are at an especially high risk of suffering the consequences of repeated sub-concussive trauma? The National Institutes of Health recently awarded $16 million in grants to physicians and researchers to investigate these questions and to develop better methods of diagnosing early CTE while athletes are still alive, whether using novel imaging techniques or blood tests. None of the $30 million allocated toward research the NFL agreed to pay as part of a class action lawsuit will be used for the studies (per ESPN) because of concerns from the NFL that the researchers will be "biased". Of course they would think that. For years, the NFL's modus operandi has been to attack the credibility of scientists who report objective findings counter to what the NFL would like the public know.

2) Somehow, the disgraced Elliot Pellman is still gainfully employed by the NFL in some capacity related to the health of its players. Recall that Dr Pellman, a trained rheumatologist (?!?!?!), was the chairman of the NFL's Mild Traumatic Brain Committee from the 1990's. This Orwellian "committee" functioned as a mouthpiece for NFL propaganda. Specifically, his group authored a series of 6 peer reviewed articles that trivialized the long-term impact of head trauma of players. Here is a conclusion from a retrospective 6 year study his group published in the journal Neurosurgery:

​CONCLUSION:Players who are concussed and return to the same game have fewerinitial signs and symptoms than those removed from play. Return to play does notinvolve a significant risk of a second injury either in the same game or during theseason. The current decision-making of NFL team physicians seems appropriate forreturn to the game after a concussion, when the player has become asymptomatic anddoes not have memory or cognitive problems.

This was from 2005! This hack rheumatologist (a medical specialist trained to treat lupus, scleroderma and other auto-immune diseases) was actually advocating that clearly concussed players would be better off returning to game action instead being forced to sit out the rest of the contest! Also from Deadspin:​

He once personally sent a concussed Wayne Chrebet back onto the field soon after he had been knocked unconscious by a hit, reportedly telling him, “This is very important for your career.” He called the work of Dr. Bennet Omalu, the first doctor to publish data linking football players to CTE, “completely wrong.”

Dr Omalu, of course, is credited with discovering CTE as a distinct disease in 2002 after performing an autopsy on the late Steelers center Mike Webster. His paper in Neurosurgery-- "Chronic Traumatic Encephalopathy in an NFL player"--- from 2005 elicited strong condemnation from Pellman's little agitprop committee. They even went so far as to demand a retraction of the paper from the Neurosurgery editorial board. Pellman was subsequently quietly phased out as the data and research became so overwhelming as to make denial of the association between head trauma in NFL players and CTE absurd. It was thought that Pellman had moved on to other less harmful ventures. But no. To this day he serves as the NFL's official "medical director". It seems that as long as Dr Pellman keeps silent about the inner workings and aims of the NFL's earlier attempts to stifle Dr Omalu, he will always have a well-paid job waiting for him on Roger Goodell's payroll.

3) The NY Times published an absurd, poorly scrutinized op-ed yesterday by a pediatric neurologist named Steven Rothman entitled "Parents, Stop Obsessing Over Concussions." Dr Rothman is upset because youth participation in football has decreased from 2008-2012 and he blames exaggeration and hysteria over recent findings on CTE for the decline. His piece is a vapid, evidence free zone of conjecture and tough guy posturing. He feels that an "excessive fear" of head trauma is driving many parents to prevent their children from playing "healthy team sports", with football presumably falling into this category. He goes on the recklessly write:​

As far as I know, detailed post-mortem brain examinations looking for C.T.E. have been conducted only on military veterans, adult athletes who played for years and others with known neurological problems.

This is demonstrably false. Nathan Stiles, alluded to earlier in this post, was diagnosed with CTE at the age of 17. Ann McKee's group is finding more and more cases of CTE in young men in their twenties. The Mayo Clinic recently published a paper that found CTE in 1/3 of studied brains in men who only played contact sports in high school. The impact of repetitive head trauma is accumulative. It starts in Pop Warner. And, in some unfortunate cases, the die has already been cast once a young man has been playing football from the ages of 12-18. Dr Rothman should know this. He has done an immeasurable disservice penning his piece on such a wide spread platform like the NY Times.

4) Finally I have to comment on the recent controversy over the Odell Beckham Jr hit on Josh Norman in Sunday's Giants/Panthers NFL game. Watch this heinous play:​

His intent was strictly to cause harm. He launches himself at full speed, using his helmet as a weapon, into Norman's earhole. He ought to be banned for the rest of the season, at least. His official one game suspension is laughable. In addition, not only was Beckham's hit a dirty play, it was, in my opinion a criminal act. He should be prosecuted for assault. Don't laugh. There is a precedent for such a consequence. Marty McSorley, a notoriously dirty hockey player from the 80's and 90's was convicted in Canadian court for assault for this ill timed swipe at the head of Donald Brashear in a game:

The NFL could have taken a stand on the sort of wanton violence, unrelated to the flow of play, that Beckham engaged in. Instead, it's a slap on the wrist. The playoffs are just around the corner.....